Provider Demographics
NPI:1164561460
Name:PARR, PHYLLIS E (RNP)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:E
Last Name:PARR
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 W 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3007
Mailing Address - Country:US
Mailing Address - Phone:651-241-1000
Mailing Address - Fax:
Practice Address - Street 1:1026 7TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3828
Practice Address - Country:US
Practice Address - Phone:651-241-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR094285-4363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN095717800Medicaid
MNA901106Medicare UPIN
MN500002607Medicare ID - Type Unspecified